OBJECTIVE: Abnormal relative positioning of the superior mesenteric artery (SMA) and vein (SMV) can lead to intestinal malrotation that predisposes to midgut volvulus. The aim of this study was to assess the prenatal ultrasound ability to visualize the relative position of SMA and SMV in normal pregnancies.
METHODS: Prospective cohort study performed in Montpellier University Hospital Centre, including 80 fetuses during routine 3rd trimester ultrasound scan. For each fetus included, the relative position of the vessels on an axial image was defined as SMV on the right, forward, or on the left of SMA. Doppler imaging was additionally used if necessary. Data were compared to the neonatal abdominal scans performed by pediatric radiologist.
RESULTS: The superior mesenteric vessels were identified in 79 fetuses. Prenatal findings showed a usual relative position of the vessels, that is, the vein on the right of the artery, in 96.2%. In 2 cases, the vein was strictly in front of the artery, and in 1 case, the vein was on the left side of the artery. Seventy-four neonates were examined and comparison with prenatal finding showed a perfect agreement (Kappa coefficient of 100%). An intestinal malrotation was postnatally diagnosed corresponding to the case where vein was on the left side of the artery.
CONCLUSIONS: This study showed that the relative position of the SMA and SMV could be assessed using ultrasound prenatal examination with a perfect agreement with postnatal findings. In case of abnormal vessels positioning more examinations should be promote including prenatal MRI and postnatal conventional radiologic examinations to confirm intestinal malrotation.

UNASSIGNED: Arteritis refers to all infectious and non-infectious conditions that lead to inflammation of the arterial wall. However, little is known about its presence in patients with coronavirus disease 2019 (COVID-19). Most patients improved with steroids along with conservative treatments in a few studies. We report our experience with superior mesenteric artery (SMA) arteritis causing an aneurysm following COVID-19 infection.
UNASSIGNED: A 66-year-old female patient who was infected with COVID-19 1 month prior presented with abdominal pain. A computed tomography scan revealed proximal SMA arteritis. Although preliminary antibacterial treatment was initiated, the follow-up CT revealed an aggressive and fast-growing 5.7-cm SMA aneurysm. Subsequently, an open interposition bypass of the SMA aneurysm was performed successfully. As the specimens retrieved during surgery showed no bacterial colonization in the tissue or blood cultures, the patient was discharged without complications.
UNASSIGNED: The mechanism of arteritis in patients with COVID-19 has not been elucidated. In the absence of evidence of bacterial infection in arteritis, it is necessary to consider the possibility of viral infection caused by COVID-19 during the COVID-19 pandemic era and start with high-dose steroid therapy promptly.

Background: This case report describes a novel endovascular technique for treating superior mesenteric artery (SMA) occlusion, a condition leading to chronic mesenteric ischemia (CMI). Traditional treatment methods for CMI, primarily due to SMA stenosis, are often complex and risky, particularly for patients unsuitable for conventional surgery. Objective: This study details the application of retrograde recanalization followed by the deployment of a VIABAHN covered stent in a patient with complete SMA ostium occlusion. Methods: The procedure\'s success in re-establishing mesenteric blood flow demonstrates its potential as a less invasive, safer alternative to traditional surgical approaches. This technique\'s innovation lies in its retrograde approach, allowing for effective treatment in cases where antegrade access is unfeasible. Results: The patient showed significant symptom improvement without procedural complications, underscoring the method\'s efficacy and safety. Conclusion: These findings suggest that retrograde stent implantation can be a viable option for managing SMA occlusions, especially in high-risk surgical cases. The successful application of this technique in this case contributes to the evolving landscape of endovascular interventions in vascular surgery and offers a promising direction for future research and clinical practice in treating SMA-related conditions.

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare cause of acute abdominal pain, but could potentially be fatal to patients, and should be recognized soon in the emergency department after excluding other common causes. Computed tomography (CT) is the modality of choice for initial diagnosis and follow-up. Currently there is no evidence-based guidelines for managing SISMAD. A 58-year-old man being suspected of a mesenteric artery dissection was referred to our emergergy department. The patient was monitored, treated conservatively with anticoagulant and discharged after 3 days. Follow-up CT scans at 6 month, 1 year and 1 year and a half post discharge showed a partially occluded false lumen, the diameter of true lumen had increased in size and no signs of bowel ischemia. SISMAD should be considered as part of differential diagnoses when patients in their fifth to seventh decades of life present with acute abdominal pain. Treatment includes conservative management, percutaneous endovascular interventions, or surgery, but most patients can be managed conservatively.

OBJECTIVE: To explore the value of treatment choice and clinical prognosis for Riolan\'s arch in chronic superior mesenteric artery (SMA) ischaemic disease in vascular surgery.
METHODS: The clinical data of 215 patients with SMA ischaemic disease (41 cases with Riolan\'s arch and 174 cases without) admitted to the Department of Vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University (China) from January 2019 to April 2023 were reviewed. Clinical characteristics, imaging findings, treatment, perioperative complications, and patient follow-up data were analysed to observe the impact of Riolan\'s arch on the prognosis of patients with SMA ischaemic disease.
RESULTS: There were significant differences in body mass index (Riolan\'s arch group: 22.82 ± 3.28 vs 24.03 ± 4.26 in non-Riolan\'s arch group, P = 0.049), Takayasu\'s arteritis (4.9% vs 0, respectively, P = 0.036), and secondary intervention (3.3% vs 1.9%, respectively, P < 0.001) between the two groups. Propensity score matching was used to exclude the effect of baseline data on patient outcomes. There were significant differences related to therapy method (conservative treatment, Riolan\'s arch group: 24.1% vs 39.7% in the non-Riolan\'s arch group; operative treatment, Riolan\'s arch group: 51.7% vs 20.7% in the non-Riolan\'s arch group, P = 0.014), as well as in-hospital time (9.79 ± 4.20 vs 6.86 ± 4.32, respectively, P = 0.011). There was no statistically significant difference in Kaplan-Meier curves between the two groups (log-rank test P = 0.476).
CONCLUSIONS: Riolan\'s arch plays an important compensatory role in SMA ischaemic disease, especially in chronic disease. We found significant differences in the treatment methods and length of hospital stay of Riolan\'s arch, which may suggest that Riolan\'s arch has some reference value in the choice of treatment mode.

OBJECTIVE: To evaluate the ability of 50-keV virtual monoenergetic images (VMI) to depict abdominal arteries in abdominal CT angiography (CTA) compared with 70-keV VMI with photon-counting detector CT (PCD-CT).
METHODS: Fifty consecutive patients who underwent multiphase abdominal scans between March and April 2023 were included. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were quantitatively assessed for the abdominal aorta (AA), celiac artery (CeA), superior mesenteric artery (SMA), renal artery (RA), and right hepatic artery (RHA) at both 50- and 70-keV VMI. In addition, 3D images from CTA were analyzed to measure arterial lengths and evaluate the visualization of distal branches.
RESULTS: Significantly higher SNR and CNR were observed at 50-keV compared to 70-keV VMI for all arteries: AA (36.54 and 48.28 vs. 25.70 and 28.46), CeA (22.39 and 48.38 vs. 19.09 and 29.15), SMA (23.34 and 49.34 vs. 19.67 and 29.71), RA (22.88 and 48.84 vs. 20.15 and 29.41), and RHA (14.38 and 44.41 vs. 13.45 and 27.18), all p < 0.05. Arterial lengths were also significantly longer at 50-keV: RHA (192.6 vs. 180.3 mm), SMA (230.9 vs. 216.5 mm), and RA (95.9 vs. 92.0 mm), all p < 0.001.
CONCLUSIONS: In abdominal CTA with PCD-CT, 50-keV VMI demonstrated superior quantitative image quality compared to 70-keV VMI. In addition, 50-keV VMI 3D CTA allowed better visualization of abdominal artery branches, highlighting its potential clinical advantage for improved imaging and detailed assessment of abdominal arteries.

We present a rare case of a 25-year-old woman with rheumatic heart disease who developed a superior mesenteric artery pseudoaneurysm (SMAPA) following infective endocarditis (IE). Initially, she presented with chest pain, dyspnea, and fever, leading to the diagnosis of IE and severe mitral regurgitation. After six weeks of antimicrobial therapy, she developed persistent abdominal pain. Further evaluation revealed a mycotic SMAPA, which was successfully treated with open surgical repair. Postoperatively, her abdominal pain improved significantly, and she was discharged on postoperative day five. The current case underscores the importance of maintaining a high index of suspicion for mycotic pseudoaneurysms in patients with risk factors, even when they present with nonspecific symptoms. The findings also highlight the critical role of computed tomography angiography (CTA) in accurate diagnosis and preoperative planning. The favorable outcome supports current guidelines for managing mycotic SMA pseudoaneurysms in complex scenarios, emphasizing the need for adherence to established protocols and recommendations.

BACKGROUND: Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of < 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.
METHODS: A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency > 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient\'s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection.
CONCLUSIONS: After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient\'s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient\'s successful recovery.

A visceral artery aneurysm (VAA) is a very rare and lethal vascular anomaly with dramatic consequences. The overall incidence of VAA is 5% of all abdominal artery aneurysms. The involvement of the superior mesenteric artery is even rare (incidence of 3.5-8% of all VAA). The development of superior mesenteric artery pseudoaneurysm following cardiac surgery is scarcely reported in the literature. We report a case of contained rupture of the superior mesenteric artery with no distal flow causing acute mesenteric ischemia (AMI) following double heart valve replacement surgery.

Celiac trunk and superior mesenteric artery (SMA) are the main blood supply to the liver and pancreas. The data of anatomical variations in these arteries or their branches are very important clinically and surgically. The aim of this study was to describe the different variants in these arteries through the examination of the angiographs of a large series of Egyptian individuals. This research involved 389 selective angiographies to celiac artery, its branches, and the SMA. Anatomy of the target arteries of people who experienced visceral angiograph was reviewed and the data were recorded. From the total available angiograms in this work, 286 patients (73.52%) had the standard anatomy of celiac trunk and superior mesenteric arteries, and 103 patients (26.47%) had a single or multiple vessel variation. The inferior phrenic artery originates from celiac trunk in 2.05% of patients, while quadrifurcation of the celiac trunk was noticed in only 0.51% of patients. Absence of celiac trunk is also found in 0.51% of patients. Left gastric artery showed an abnormal origin from the splenic artery in 0.51% of patients. Quadrifurcation of common hepatic artery was also noticed. Variant anatomy of the left hepatic artery (LHA) was seen in 9.51% of patients, while variations of the right hepatic artery (RHA) were 14.13%. With the different origin of hepatic arteries, the gastroduodenal artery arose either from the LHA (2.82%), RHA (2.31%) or even from the celiac trunk (1.79%).